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Biomedical subjects

R H Pickler

Publications and source records attributed to R H Pickler.

16 recordsLinked to original sources
PubMed1999

Becoming a cancer patient: a study of families of children with acute lymphocytic leukemia.

This grounded theory study was designed to explore the process by which families of children with acute lymphocytic leukemia (ALL) "become" cancer patients. Data were obtained through interviews with four families and three professional caregivers and were analyzed for processes by which families experience the illness of ALL. The central process of "becoming" was defined as trying to live as "normally" as possible; accepting that life is not the same; understanding what you have to do; and accepting what you can't change/living with dissatisfactions. This process was mediated by families' external contexts, including marital relationships and support networks, experiential contexts, including positive and negative experiences during treatment and previous illness experiences, and internal contexts, including personal survival strategies and personal outlooks and attitudes. The process illustrates the pattern of experience that occurs in families faced with the diagnosis of their child's ALL. Understanding this process may be useful to care providers when treating children with cancer.

Activities of Daily Living↗
PubMed1999

Patterns of genetic inheritance.

Neonatal nurses need to understand the basic patterns of genetic transmission. This article, the first in a series, provides an overview of Mendel's laws and discusses five types of transmission: single gene inheritance, chromosomal inheritance, multifactorial inheritance, cytoplasmic inheritance, and somatic cell mutations.

Extrachromosomal Inheritance↗
PubMed1997

Contamination in expressed breast milk following breast cleansing.

The purpose of this study was to determine if preexpression breast cleansing reduced the bacterial count in expressed breast milk. The study involved the collection of 178 breast milk samples (89 matched samples); 38 matched samples were from mothers of term infants and 51 matched samples were from mothers of preterm infants. One half of the samples were collected following breast cleansing with Phisoderm and tap water. The other half were collected following breast cleansing with tap water only. Hand and equipment washing with Phisoderm and tap water preceded all sample collections. Storage containers were sterile. Samples were cultured for pathogenic and nonpathogenic bacteria and examined at 24 and 48 hours. Data were analyzed by Wilcoxon Matched-Pairs sign test and Chi square. Breast cleansing with Phisoderm and water was not more effective than water alone at reducing nonpathogenic bacteria or eliminating pathogenic bacteria. Mothers of preterm infants had higher levels of both nonpathogenic and pathogenic bacteria than mothers of full-term infants. The most common form of bacterial contamination was coagulase-negative Staphylococcus epidermidis. This particular bacteria is found in higher levels in the stools of breast fed infants than formula fed infants and it also the most common contaminant found in the blood of preterm infants who develop sepsis. The findings of this study reveal that chemical interventions may not be effective at rendering breast milk free from pathogenic bacteria. More research is needed to determine the optimal cleansing protocol to achieve bacterial decontamination of breast milk or to determine the clinically acceptable level of contamination based on the effects on infants.

Chi-Square Distribution↗
PubMed1996

Advanced practice nursing in the care of the high-risk infant.

Advanced practice nursing encompasses a range of roles and services. Tertiary care settings such as neonatal intensive care units provide a variety of opportunities for the advanced practice nurse, including direct care, case management, and developmental care. Primary care and community settings may also provide opportunities for advanced practice nursing in the care of high-risk infants. Challenges related to role implementation, control of practice, and reimbursement also exist, however. The article examines the evolution of advanced practice nursing in the care of the high-risk infant as well as current opportunities and challenges.

Career Mobility↗
PubMed1996

The basis of heredity: a genetic primer.

Traits seen in the neonate are a direct result of the expression of genes donated by parents at the time of conception. This article discusses the configuration of genetic material in humans, explains how an individual's genetic composition is unique, and demonstrates the importance of genetic information in determining traits related to health, disease, and individuality.

Genetics, Medical↗
PubMed1996

Inherited disorders: a genetic primer.

Identification of inherited or genetic disorders has important implications for the prognosis and treatment of affected infants. This article addresses the three most common categories of genetic disorders--single-gene defects, chromosomal abnormalities, and multifactorial conditions. The principles of transmission, risk of inheritance, and clinical significance of each category are discussed, with examples of inherited disorders in each category.

Female↗
PubMed1995

Gene therapy for inherited disorders.

With an increase in understanding of the role of genes in disease pathogenesis, gene therapy has become a reality for some disorders and an increased possibility for many others. One type of gene therapy requires only gene addition for treatment. Different methods for gene addition are being tested, based on the cell typology necessary to make the therapy effective. Gene therapy trials for patients with adenosine deaminase deficiency involve a retroviral approach. Gene therapy trials for patients with cystic fibrosis involve an adenoviral approach. This article describes the differences between these two methods of gene therapy. The application of this knowledge to pediatric nursing practice is discussed.

Adenosine Deaminase↗
PubMed1994

Blastomere analysis: issues for discussion.

There has been little professional discussion about the implications of blastomere analysis for genetic screening. In this article, some of the legal, ethical, and practical issues associated with the technology are identified. Issues are categorized as those involving availability and payment, phenotype selection, and imperfect genes. Nurses need to be knowledgeable about these issues to participate in the formation of policies governing the use of blastomere analysis and other genetic screening procedures.

Blastomeres↗
PubMed1994

Nonnutritive sucking and necrotizing enterocolitis.

The purpose of this study was to explore the possible protective effect of nonnutritive sucking (NNS) against the development of necrotizing enterocolitis (NEC). A retrospective chart review was conducted to examine the histories of 12 preterm infants who were enrolled in a longitudinal study of the effects of NNS on energy expenditure, weight gain, and feeding readiness. Six infants were enrolled in the control group; they did not receive NNS but did develop NEC. Six infants were in the experimental group and did not develop NEC. The groups were compared on the basis of clinical correlates associated with NEC. These included race, gender, birth weight, five-minute Apgar, maternal bleeding, maternal age, and length of ruptured membranes. For infants who developed NEC, the number of clinical correlates ranged from one to four. For infants who received NNS, the range of clinical correlates was from one to five. It is not possible to conclude from this study that NNS protects preterm infants from NEC. Prospective studies of larger sample sizes that involve examination of the effect of NNS on gastric motility and enzyme and hormone secretion are needed.

Enterocolitis, Pseudomembranous↗
PubMedDate not supplied

Effects of nonnutritive sucking on behavioral organization and feeding performance in preterm infants.

The purpose of this study was to examine the effects of nonnutritive sucking (NNS) on behavioral organization and feeding performance in preterm infants. Thirteen preterm infants were observed at four bottle-feedings, two of which involved treatment with prefeeding NNS. NNS had a positive effect on oxygen saturation and behavior state, as well as on the initiation and duration of the first nutritive suck burst.

Bottle Feeding↗
PubMedDate not supplied

The effect of nonnutritive sucking on bottle-feeding stress in preterm infants.

OBJECTIVE: To examine the effects of nonnutritive sucking on the physiologic and behavioral stress reactions of preterm infants at early bottle feedings and to examine the effect of nonnutritive sucking on the feeding performance of preterm infants at early bottle feedings. DESIGN: Quasi-experimental with a matched sample. SETTING: A level III neonatal intensive-care unit in a large medical center. PARTICIPANTS: Twenty preterm infants whose gestational ages at birth ranged from 26 to 34 weeks. INTERVENTIONS: Ten infants were provided nonnutritive sucking for 5 minutes before and 5 minutes after an early bottle feeding. Ten infants served as controls. MAIN OUTCOME MEASURES: Physiologic stress was measured by heart rate and oxygen saturation rate. Behavioral stress was measured by observation of behavioral state. Feeding performance was measured by duration, percentage of formula taken by bottle, and behavioral state after feeding. RESULTS/CONCLUSIONS: Infants who received nonnutritive sucking before and after bottle feedings were more likely to be in a quiescent behavior state 5 minutes after the feeding (p = .01) and had higher feeding performance scores (p = .01) than infants who did not receive nonnutritive sucking.

Bottle Feeding↗
PubMedDate not supplied

The technology and use of blastomere analysis.

With the use of blastomere analysis, it is possible to screen for serious genetic disease before initiating pregnancy through in vitro fertilization. The analysis provides information about an embryo's genetic composition before implantation. This article describes the technique of blastomere analysis and its current and potential uses. Implications for nursing practice and education are identified.

Blastomeres↗
PubMedDate not supplied

Bottle-feeding histories of preterm infants.

OBJECTIVE: To describe the bottle-feeding histories of preterm infants and determine physical indices related to and predictive of bottle-feeding initiation and progression. DESIGN: Ex post facto. SETTING: Academic medical center. PARTICIPANTS: A convenience sample of 40 preterm infants without concomitant cardiac, gastrointestinal, or cognitive impairment. MAIN OUTCOME MEASURES: Postconceptional age at first bottle-feeding, full bottle-feeding, and discharge. RESULTS: The morbidity rating, using the Neonatal Medical Index (NMI), was most strongly correlated with postconceptional age at first bottle-feeding (r = .34, p < .05), full bottle-feeding (r = .65, p < .01), and discharge (r = .55, p < .05). The morbidity rating also accounted for 12%, 42%, and 30% of the variance in postconceptional age at first bottle-feeding, full bottle-feeding, and discharge, respectively. CONCLUSIONS: The NMI may be a useful tool for predicting the initiation and progression of bottle-feeding in preterm infants.

Age Factors↗
PubMedDate not supplied

Mastery of stress in mothers of preterm infants.

PURPOSE: To explore the relationships among stress, social support, mastery, and depression. DESIGN: Descriptive correlational study. SETTING: 60-bed, Level 3 NICU in an urban medical center in a Mid-Atlantic state. PARTICIPANTS: 31 mothers who delivered infants born between 26 and 36 weeks gestation. Inclusion criteria included no maternal illness or complications requiring hospitalization beyond four days, and no report of a recent major stressful life event other than the birth of the child. MAJOR OUTCOME MEASURES: The Mastery of Stress Instrument, the Account of Social Resources Inventory, and the Center for Epidemiologic Studies-Depression Scale. RESULTS: Social support was positively related to mastery and inversely related to depression. CONCLUSIONS: Mothers of preterm infants experienced significant levels of stress and depression in the early postpartum period.

Adaptation, Psychological↗